Burns

Third-Degree Burns

Third-degree burns are the most serious type of burn and involve all the layers of the skin and underlying tissue:

• Signs and symptoms: The surface appears dry and can look waxy white, leathery, brown, or charred. There may be little or no pain or the area may feel numb at first because of nerve damage.
• Healing time: Healing time depends on the severity of the burn. Deep second- and third-degree burns (called full-thickness burns) will likely need to be treated with skin grafts, in which healthy skin is taken from another part of the body and surgically placed over the burn wound to help the area heal.

What to Do

Seek Medical Help Immediately When:

• You think your child has a second- or third-degree burn.
• The burned area is large (2-3 inches in diameter), even if it seems like a minor burn. For any burn that appears to cover more than 10% of the body, call for medical assistance. And don't use wet compresses or ice because they can cause the child's body temperature to drop. Instead, cover the area with a clean, soft cloth or towel.
• The burn comes from a fire, an electrical wire or socket, or chemicals.
• The burn is on the face, scalp, hands, joint surfaces, or genitals.
• The burn looks infected (with swelling, pus, increasing redness, or red streaking of the skin near the wound).

For First-Degree Burns:

• Remove the child from the heat source.
• Remove clothing from the burned area immediately.
• Run cool (not cold) water over the burned area (if water isn't available, any cold, drinkable fluid can be used) or hold a clean, cold compress on the burn for approximately 3-5 minutes (do not use ice, as it may cause more destruction to the injured skin).
• Do not apply butter, grease, powder, or any other remedies to the burn, as these can make the burn deeper and increase the risk of infection.
• Apply aloe gel or cream to the affected area. This may be done a few times during the day.
• Give your child acetaminophen or ibuprofen for pain. Refer to the dosing guidelines on the label according to your child's age or weight.
• If the area affected is small (the size of a quarter or smaller), keep it clean. You can protect it with a sterile gauze pad or bandage for the next 24 hours (but do not use adhesive bandages on very young kids, as these can be a choking hazard).

For Second- and Third-Degree Burns:

• Seek emergency medical care, then follow these steps until medical personnel arrive:
  • Keep your child lying down with the burned area elevated.
  • Follow the instructions for first-degree burns.
  • Remove all jewelry and clothing from around the burn (in case there's any swelling after the injury), except for clothing that's stuck to the skin. If you're having difficulty removing clothing, you may need to cut it off or wait until medical assistance arrives.
  • Do not break any blisters.
  • Apply cool water over the area for at least 3-5 minutes, then cover the area with a clean dry cloth or sheet until help arrives.

What to Do (continued)

For Flame Burns:

• Extinguish the flames by having your child roll on the ground.
• Cover him or her with a blanket or jacket.
• Remove smoldering clothing and any jewelry around the burned area.
• Call for medical assistance, then follow instructions for second- and third-degree burns.

For Electrical and Chemical Burns:

• Make sure the child is not in contact with the electrical source before touching him or her, or you also may get shocked.
• For chemical burns, flush the area with lots of running water for 5 minutes or more. If the burned area is large, use a tub, shower, buckets of water, or a garden hose.
• Do not remove any of your child's clothing before you've begun flushing the burn with water. As you continue flushing the burn, you can then remove clothing from the burned area.
• If the burned area from a chemical is small, flush for another 10-20 minutes, apply a sterile gauze pad or bandage, and call your doctor.
• Chemical burns to the mouth or eyes require immediate medical evaluation after thorough flushing with water.

Although both chemical and electrical burns might not always be visible, they can be serious because of potential damage to internal organs. Symptoms may vary, depending on the type and severity of the burn and what caused it and may include abdominal pain.

If you think your child may have swallowed a chemical substance or an object that could be harmful (for instance, a watch battery), first call poison control and then the emergency department.

It is helpful to know what chemical product the child has swallowed or has been exposed to. You may need to take it with you to the hospital. Keep the number for poison control, (800) 222-1222, in an easily accessible place, such as on the refrigerator.

Preventing Burns

You can't keep kids free from injuries all the time, but these simple precautions can reduce the chances of burns in your home:

In General

• Keep matches, lighters, chemicals, and lit candles out of kids' reach.
• Put child-safety covers on all electrical outlets.
• Get rid of equipment and appliances with old or frayed cords and extension cords that look damaged.
• If you need to use a humidifier or vaporizer, use a cool-mist model rather than a hot-steam one.
• Choose sleepwear that's labeled flame retardant (either polyester or treated cotton). Cotton sweatshirts or pants that aren't labeled as sleepwear generally aren't flame retardant.
• Make sure older kids and teens are especially careful when using irons, flat irons, or curling irons.
• Prevent house fires by making sure you have a smoke alarm on every level of your home and in each bedroom. Check these monthly and change the batteries twice a year.
• Replace smoke alarms that are 10 years or older.
• Don't smoke inside, especially when you're tired, taking medications that can make you drowsy, or in bed.
• Don't use fireworks or sparklers.

Bathroom

• Set the thermostat on your hot water heater to 120ºF (49ºC), or use the "low-medium setting." A child can be scalded in 5 seconds in water if the temperature is 140ºF (60ºC). If you're unable to control the water temperature (if you live in an apartment, for example), install an anti-scald device, which is relatively inexpensive and can be installed you or by a plumber.
• Always test bath water with your elbow before putting your child in it.
• Always turn the cold water on first and turn it off last when running water in the bathtub or sink.
• Turn kids away from the faucet or fixtures so they're less likely to play with them and turn on the hot water.

Preventing Burns (continued)

Kitchen/Dining Room

• Turn pot handles toward the back of the stove every time you cook.
• Block access to the stove as much as possible.
• Never let a child use a walker in the kitchen (the American Academy of Pediatrics strongly discourages the use of walkers overall).
• Avoid using tablecloths or large placemats. Youngsters can pull on them and overturn a hot drink or plate of food.
• Keep hot drinks and foods out of reach of children.
• Never drink hot beverages or soup with a child sitting on your lap or carry hot liquids or dishes around kids. If you have to walk with hot liquid in the kitchen (like a pot of soup or cup of coffee), make sure you know where kids are so you don't trip over them.
• Never hold a baby or small child while cooking.
• Never warm baby bottles in the microwave oven. The liquid may heat unevenly, resulting in pockets of breast milk or formula that can scald a baby's mouth.
• Screen fireplaces and wood-burning stoves. Radiators and electric baseboard heaters may need to be screened as well.
• Teach kids never to put anything into the fireplace when it is lit. Also make sure they know the glass doors to the fireplace can be very hot and cause a burn.

Outside/In the Car

• Use playground equipment with caution. If it's very hot outside, use the equipment only in the morning, when it's had a chance to cool down during the night.
• Remove your child's safety seat or stroller from the hot sun when not in use because kids can get burns from hot vinyl and metal. If you must leave your car seat or stroller in the sun, cover it with a blanket or towel.
• Before leaving your parked car on a hot day, hide the seatbelts' metal latch plates in the seats to prevent the sun from hitting them directly.
• Don't forget to apply sunscreen when going outside. Use a product with the SPF of 15 or higher. Apply sunscreen 20-30 minutes before going out and reapply every 2 hours or more often if in water. Do not use sunscreen on infants under 6 months of age — they should be kept out of the sun.

Reviewed by: Mary Mondozzi, MSN, RN, CPNP
Date reviewed: January 2012